Revista Argentina de Cirugía

In memoriam: Professor Dr. Eduardo Nicolás Saad

Alfredo Lafuente, Leonardo Serrano — Thu, 25 Sep 2025 00:00:00 +0000

Editorial on: "Results of a national survey on the current status of laparoscopic D2 gastrectomy in Argentina"

Federico Cuenca Abente — Sun, 17 Aug 2025 00:00:00 +0000

Eulogy to Dr. Juan Miguel Acosta

Sung Ho Hyon — Thu, 18 Sep 2025 00:00:00 +0000

Gallbladder duplication. A case report

Paola de los A. Navarro, Juan M. Maldonado, Luis M. Mercado, Pablo A. Farinelli — Fri, 12 Sep 2025 00:00:00 +0000

Gallbladder duplication, a rare congenital malformation resulting from embryonic dysgenesis, occurs in one out of every 4,000 births. A preoperative diagnosis is important to avoid complications during surgery and the need for additional procedures. Here, we present the case of a 24-year-old female patient who sought medical care due to biliary colic. An abdominal ultrasound revealed cholelithiasis and a bifid gallbladder. Magnetic resonance cholangiopancreatography revealed complete gallbladder duplication with two separate cystic ducts, corresponding to Type E of Boyden’s classification. One gallbladder contained stones, and the other had abundant biliary sludge. The preoperative diagnosis made it possible to perform a successful laparoscopic cholecystectomy. Intraoperatively, gallbladder duplication was identified, along with two separate cystic ducts that independently entered the common bile duct and left hepatic duct, respectively.

Appendiceal mantle cell lymphoma presenting as acute appendicitis

Thu, 25 Sep 2025 00:00:00 +0000

In 70% of the cases of mantle cell lymphoma, extranodal involvement is the initial manifestation, with the gastrointestinal tract being the most commonly affected site. In approximately 1% of appendectomies, a neoplasm is discovered during the histological examination. We report the case of an 81-year-old male patient with a history stage IV mantle cell lymphoma who presented with abdominal pain and was diagnosed with acute appendicitis. The patient underwent laparoscopic appendectomy. Pathological examination of the surgical specimen revealed that the appendix was fully compromised by a diffuse small cell lymphoma. Appendiceal neoplasms are rare, and the diagnosis is made histologically. These neoplasms can be suspected when the diameter of the appendix is > 15 mm. The incidence of appendiceal lymphoma is low. The pathogenesis of lymphoma as a cause of appendicitis remains unknown; however, there are several theories that have been postulated.

Synovial sarcoma of the thyroid gland: an unusual finding

Sun, 17 Aug 2025 00:00:00 +0000

Synovial sarcoma is a rare form of soft tissue sarcoma, and its prevalence is highest among adolescents and young adults. Although it is more common in the limbs, it can also occur in the viscera. We report the case of a 28-year-old woman who presented with a left-sided neck mass present for five months, accompanied by progressive dysphagia. The results of ultrasound and fine needle aspiration were suggestive of malignancy. The case was interpreted as thyroid gland neoplasm. Consequently, a total thyroidectomy with central lymph node clearance was performed. The lesion was diagnosed as synovial sarcoma using immunohistochemistry and molecular biology. Eight months later, the patient presented a local recurrence requiring new surgery. Although synovial sarcoma is rare on this site, it should be considered in the differential diagnosis of neck masses and a multidisciplinary approach should be taken for its proper diagnosis and treatment.

Dasatinib, a rare cause of drug-induced chylothorax

Thu, 25 Sep 2025 00:00:00 +0000

Chylothorax is the extravasation of milky chyle rich in triglycerides into the pleural cavity. The etiology of chylothorax includes malignant obstructions and lymphatic pleural fistulas due to thoracic surgery or trauma. Ten percent of the cases are idiopathic and is considered a rare occurrence resulting from drug use. We report the case of a 31-year-old male patient with a history of chronic myeloid leukemia treated with dasatinib, who presented with cough and progressive dyspnea, with no other symptoms. The chest X-ray and computed tomography showed right pleural effusion. Thoracocentesis yielded cloudy and milky-white pleural fluid. Biochemical analysis of the pleural fluid revealed the presence of chylothorax. Conservative treatment was the first therapeutic option with a dietary plan supplemented with mediumchain triglycerides, followed by pleural drainage and discontinuation of dasatinib, pleurodesis and switch to bosutinib. At two years of follow-up, chylohorax or pleural effusion did not recur.

Neuromonitoring of the recurrent laryngeal and vagus nerves in thyroid and parathyroid surgery: historical evolution and current state of the art

Manuel A. Villar, José M. Fernández Cebrián — Thu, 25 Sep 2025 00:00:00 +0000

Neuromonitoring of the recurrent laryngeal and vagus nerves has evolved significantly since its inception, and it has become an essential tool in thyroid surgery and associated procedures. This article describes the historical evolution of neuromonitoring, its technological development, and its implementation in current medical practice. The review includes the techniques used and the importance of neuromonitoring of the recurrent laryngeal nerve and vagus nerve. In addition, best practices and challenges currently faced by surgeons are analyzed. Through an extensive and up-to-date review of publications on the subject, this article offers an outlook on the future of neuromonitoring in the surgical field. The need for adequate training and integration of new technologies is essential to optimize patients’ outcomes and the education and training of specialists.

High-resolution esophageal manometry. Initial experience in a department of general surgery

Javier Chinelli, Gustavo Rodríguez — Thu, 25 Sep 2025 00:00:00 +0000

Background: Manometry is considered the gold standard for the diagnosis of motility disorders of the esophagus. There are currently no national reports documenting the use and results of high-resolution manometry (HRM).
Objective: The aim of this study is to describe the technique and the results of the initial use of HRM in patients with gastroesophageal disorders.
Material and methods: We conducted an observational and retrospective study using the clinical records of patients referred for HRM for assessment of gastroesophageal disorders between June 2019 and June 2014. Motility disorders were defined according to the Chicago classification v3.0.
Results: The clinical records of 89 patients were analyzed. The reasons for evaluation were
gastroesophageal reflux (GER), preoperative assessment of bariatric surgery and revision surgery, functional dysphagia, failed Heller myotomy and non-cardiac chest pain. All the patients had previously undergone an endoscopic evaluation. The following parameters were evaluated in each case: morphology of the esophagogastic junction (EGJ), deglutitive EGJ relaxation, propagation of the peristaltic wave, contractile vigor of the esophageal body, peristaltic integrity and pressurization pattern. Most motility disorders occurred in the GER group.
Conclusion: High-resolution esophageal manometry provided relevant information for the diagnosis and treatment of diverse gastroesophageal disorders.

Analysis on the use of digital tools by generations in the departments of surgery

Wed, 03 Sep 2025 00:00:00 +0000

Background: The departments of surgery in public hospitals are staffed by a diverse group of professionals who, depending on years year of their birth, are classified as Baby Boomers, Generation X, Millennials and Generation Z. The introduction of digital tools (DTs) has transformed medical practice by optimizing healthcare activities, academic activities and administrative activities. However, their use in the surgical field has not yet been investigated in relation to different generations.
Objective: The aim of the present study was to analyze the type of DTs used by physicians in the departments of surgery and their frequency of use, according to the generation to which they belong.
Material and methods: We conducted an observational, descriptive and cross-sectional study to analyze the frequency of use of DTs among physicians of the department of surgery at a public hospital. A self-administered questionnaire with 10 closed questions was distributed primarily via instant messaging.
Results: The response rate was 60% (n = 89), with 81% (44/54) of residents and 47% (45/95) of staff physicians responding. Younger generations (Millennials and Generation Z) engage with digital tools more frequently than older generations, particularly using communication and educational apps.
Conclusion: Millennials and Generation Z used more types of DTs and more frequently than other generations.

Predictive ability of the leukocyte-glucose index for detecting surgical site infections in patients with acute appendicitis

Thu, 25 Sep 2025 00:00:00 +0000

Background: Surgical site infections (SSIs) are one of the most common postoperative complications in acute appendicitis (AA). At present, there is a paucity of tools to predict its onset in early stages.
Objective: The aim of this study was to evaluate the predictive ability of the leukocyte-glucose index (LGI) for detecting SSIs in patients with AA.
Material and methods: We conducted an analytical and retrospective diagnostic test research study based on 500 medical records of patients with AA, of which 100 developed SSI. The LGI values were evaluated and their diagnostic performance was calculated using ROC curves, sensitivity, specificity, predictive values, and likelihood ratios.
Results: The area under the curve (AUC) for LGI was 0.863 (95% CI: 0.823-0.904, p < 0.001), and a cutoff point of 1.714 was determined, with a sensitivity of 81% and a specificity of 79.5%. The positive post-test probability was 50% and the negative post-test probability was 6%.
Conclusions: The LGI exhibited good performance as a predictor of SSI in AA. The simplicity and availability of this tool make it a useful asset in healthcare practice. Yet, the results of this study must be interpreted within the local clinical and epidemiological context.

Results of a national survey on the current status of laparoscopic D2 gastrectomy in Argentina.

Sun, 27 Jul 2025 00:00:00 +0000

Background: The treatment of advanced gastric cancer involves a radical gastrectomy and adequate lymphadenectomy. The results of laparoscopic surgery are similar to those of open surgery.
Objective: The aim of this study was to gather information from centers performing laparoscopic D2 gastrectomy (LD2G) procedures in Argentina and to compare the morbidity, mortality and oncological outcomes in high- versus low-volume centers.
Materials and methods: We conducted a national survey of centers performing LD2G procedures and recorded morbidity, mortality, and pathological findings. The sample was divided into two groups according to the number of LD2G procedures performed annually: those performing ≥ 20 and <20.
Results: Seventeen centers responded the survey of which 4 (23.6%) perform ≥ 20 LD2G procedures.
The mean number of procedures per year was 6.5 in group < 20, and 30 in group ≥ 20. In group < 20, mean operative time was 220 minutes, conversion rate was 8.3%, the mean number of lymph nodes dissected was 18.4, and the percentage of clear margins was 92.1%. In group ≥20, mean operative time was 290 minutes, conversion rate was 8.6%, the mean number of lymph nodes dissected was 30.5, and the percentage of clear margins was 93.1%. Major complications occurred in 11.8% of the cases in group <20 and in 17.3% in group ≥20. Mortality rates were 4.6% and 2.7%, respectively.
Conclusions: The medical centers performing ≥20 LD2G procedures per year demonstrate enhanced oncological outcomes and lower mortality with a morbidity rate similar to the one reported in the literature.

What should I ask myself before starting research on human subjects?

Rosa Angelina Pace — Thu, 18 Sep 2025 00:00:00 +0000

In a text that is now part of the classic literature on ethics, Ezekiel Emanuel states:
“Why does clinical research, meaning on human subjects, need special ethical requirements?
Why is it that good scientific research alone is not enough? Is good science not equivalent to good ethics? These are common questions, especially for clinical researchers. (Note that clinical research refers to research on human subjects, whatever it may be,
including surgical research).